Provider Demographics
NPI:1316419260
Name:GOLAN INTEGRATED PHYSICAL MEDICINE
Entity type:Organization
Organization Name:GOLAN INTEGRATED PHYSICAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-419-5379
Mailing Address - Street 1:PO BOX 561564
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-1564
Mailing Address - Country:US
Mailing Address - Phone:702-202-1850
Mailing Address - Fax:
Practice Address - Street 1:3097 29TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-1726
Practice Address - Country:US
Practice Address - Phone:616-741-2232
Practice Address - Fax:877-866-2053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLAN INTEGRATED PHYSICAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-17
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty